COMLEX-USA Practice Test

COMLEX Level 1

COMLEX Format and Test Structure

As mentioned above, the COMLEX is a series of licensing examination broken into three levels:

A problem-and-symptom-based test, conducted in a time-based setting that combines fundamental biomedical sciences and other fields of medical knowledge related to the resolution of clinical issues and the promotion and preservation of health in the delivery of osteopathic medical treatment to patients.

Foundational Biomedical Sciences:
       ● Anatomy
       ● Behavioral Science
       ● Biochemistry
       ● Genetics
       ● Health Promotion and Disease Prevention
       ● Immunology
       ● Microbiology
       ● Osteopathic Principles and Practice
       ● Pathology
       ● Pharmacology
       ● Physiology

COMPLEX Level 1 Prep

Here are the best COMLEX Level 1 Prep resources:
       1. COMBANK
       2. Uworld
       3. First Aid for Step 1
       4. COMSAE and NBME practice exams
       5. OMT Review by Savarese

Note: Questions can be answered, reviewed, and changed one subsection at a time. Individual subsections are not timed.

Candidates can also sharpen their skills with our NBME practice exam 2026, which includes hundreds of practice questions in the exact format and difficulty of the real exam.

COMLEX Level 2

1. Cognitive Evaluation (CE) - a one-day computer-based test that combines the integration of expertise in clinical science and basic biomedical and osteopathic disciplines with other medical skills relevant to patient care and health promotion in regulated clinical settings.

Clinical Sciences Disciplines
       ● Emergency Medicine
       ● Family Medicine
       ● Health Promotion and Disease Prevention
       ● Internal Medicine
       ● Neurology
       ● Obstetrics/Gynecology
       ● Osteopathic Principles and Practice
       ● Pediatrics
       ● Psychiatry
       ● Surgery

Note: Questions can be answered, reviewed, and changed one subsection at a time. Individual subsections are not timed.

2. Performance Evaluation (PE) - a patient-based evaluation of the core clinical skills measured across 12 sessions with regular patients. The applicant must personally conduct the clinical skills of standardized clients in a timely, secure, effective, and safe way, as necessary.

Fundamental Clinical Skills Assessed
● Humanistic Domain
       ○ Physician-Patient Communication
       ○ Interpersonal skills
       ○ Professionalism

● Biomedical/Biomechanical Domain
       ○ Medical History-Taking and Physical Examination Skills
       ○ Osteopathic Principles and Osteopathic Manipulative Treatment (OMT)
       ○ Documentation Skills (including synthesis of clinical findings, integrated differential diagnosis, and                              formulation of a diagnostic and treatment plan)

COMLEX Level 3

A two-day computer-based assessment of competence in the field of basic competence needed for general practitioners to provide effective and safe osteopathic medical treatment and to improve health in unmonitored clinical settings. The exam combines multiple-choice questions (MCQ) with clinical decision-making (CDM) cases.

Note: Questions can be answered, reviewed, and changed one subsection at a time. Individual subsections are not timed. Each CDM case includes two to four questions that assess data acquisition, data interpretation, and treatment/management decisions.

Upcoming format change: Effective January 13, 2027, NBOME will shift COMLEX-USA Level 3 to a one-day exam with four 2-hour sessions, 240 multiple-choice questions, and 16 CDM cases. Check the current NBOME Bulletin of Information for the exact format in effect on your test date.

COMLEX Level 3 Prep

How to study for COMLEX Level 3? Here are the best resources to use:

       1. First Aid and Step 2/Level 2 Review Books
       2. OMM Review
       3. Qbanks: Uworld and Comquest
       4. Practice Exams
       5. NBOME Resources

COMLEX Scoring System

Scoring for the COMLEX tests is determined by the number of questions answered correctly (raw COMPLEX scores), which is converted to a standard score for the sake of reporting the results and providing the pass-fail rating.

NBOME does not disclose percentile scores in the applicant's score reports. When the evaluation process is finished, percentile scores are measured and can be obtained using the Percentile Conversion Tool.

To get your COMLEX score percentile, you must:
       1. Open the Percentile Score Converter on the NBOME website.
       2. Enter your 3-digit score into the respective field
       3. Select the examination level being converted
       4. Pick the date of the test using the drop-down menu
       5. Click the ‘CONVERT’ button
       6. The numbers appearing to the right will be the corresponding percentile scores.

Applicants will be notified via email once their scores have been posted. Applicants may view their pass/fail status and/or scores for any COMLEX test via the CRS portal on the NBOME website (Account Access Login could be found at the upper right corner of the homepage).

Score Reports are usually published to the applicant's account under the "View Score Report" and the protected school site of the NBOME CRS portal.

Note: After the initial score release, please see the score release schedule on the NBOME website.

1. Set a goal

COMLEX Prep Guide

Pick a score for each exam level that you think is attainable and set it as your goal. This will help keep you driven to study and work hard to meet and surpass your goal.

2. Start COMLEX study as soon as possible

The ideal preparation for the COMLEX is 8 to 12 months before you take the tests. If you're studying for your first COMLEX, you have to make sure that you're going to be as over-prepared as possible because not knowing what to expect could add some stress.

3. Do a minimum of 5 practice questions each day

In order to be adequately prepared for a test of 400 questions, you would need to review more than 400 questions. Doing at least 5 each day will enable you to absorb the amount of information you require. It is important to set up a study schedule, choose a starting date, and then stick to it.

4. Do not use too many resources to study

Limit your study resources to 1-2 online question banks and 1-2 books for additional study materials. This guarantees that you get the most from your study resources rather than stretching yourself thin and gaining very little from each study tool.

5. Take notes

Taking notes while reviewing helps imprint information into your brain more than memorization does.

6. Do at least one timed COMLEX practice exams

To feel totally prepared for the test date, you must take at least one timed, 400-question practice test to make you feel better about what answering the questions would be like on the test day.

COMLEX Prep course:

       ‥ Kaplan — Top Pick
       ‥ Wolf Pacc — Best Live Online Course
       ‥ Killexams — Most Affordable
       ‥ Med Learnity — Best Instructors
       ‥ PASS Program — Best Tutoring Program
       ‥ True Learn — Best Online Course
       ‥ National Board of Osteopathic Medical Examiners (NBOME) — Best Free Practice Exams

COMLEX Questions and Answers

COMLEX-USA Level 1 is reported as pass/fail (no numeric score). COMLEX-USA Level 2-CE requires a standard score of 400, and Level 3 requires a standard score of 350.

Candidates who fail an examination can retake it up to four times in a 12-month period.

Scores are generally available within two to six weeks of the testing window for Level 1 and Level 2-CE, and within eight to ten weeks of the testing window for Level 3.

You must start practicing all exam components; this will help you improve your clinical thinking quickly on test day. Select and apply the resources that will help you in achieving your goal. Make a list of all your ideas and reasons for doing each and every thing on the PE.

As of the current testing cycle, COMLEX-USA Level 1 is scored pass/fail rather than reporting a three-digit numeric score.

After graduating from their DO schools, candidates take the COMLEX Level 3 exam, generally before the completion of their Internship/first year of residency.

COMLEX-USA Level 2-CE and Level 3 report a 3-digit standard score, generally on a scale with a mean around 500; COMLEX-USA Level 1 now reports a pass/fail result instead of a numeric score. For all levels, the number of questions answered correctly (raw score) is converted to a standard score used to determine pass/fail. Each scored question counts equally toward the result, except unscored pretest questions.

The test is divided into two four-hour sessions, with a 40-minute break in between.

The test consists of four 3.5-hour computer-based test sessions split out over two days with two sessions each day.

Study timelines for COMLEX Level 2-CE vary widely by student and school curriculum; many students begin dedicated review several weeks before their test date rather than relying on a fixed number of days.

Osteopathic Principles, Practice, and Manipulative Treatment is one of several competency domains on the COMLEX-USA Blueprint; consult the current NBOME Blueprint for the exact minimum percentage weighting by level.

Each 4-hour session (Level 1 and Level 2-CE) is divided into four sections of 40 questions each, for a total of 320 questions across the full exam.

The COMLEX-USA Level 2-CE has 320 multiple-choice questions.

There are 320 questions in the COMLEX-USA Level 1 exam.

COMLEX-USA registration fees are set by the NBOME and change periodically — check the current fee schedule in the official NBOME Bulletin of Information before registering.

You must first create a personal NBOME password-protected online account in the NBOME Client Registration System before you can register for and schedule a COMLEX-USA examination. Confirm that you are eligible for the test and that you meet all of the requirements. Choose and purchase examinations. Change the date of an existing examination. Manage your payment and personal data. Read and agree to the registration terms and conditions.

If you need to reschedule, go to the Prometric website.

To do well on this test, you must know the basic scientific topics as well as osteopathic medicine. Make a study plan to figure out how many questions you’ll have to answer every day or how much information you’ll need to cover to meet your target. Take practice tests, they are essential for success on the COMLEX Level 1 exam. Choose two or three good resources and use them regularly. Before the exam, take care of yourself.

First, make a schedule for your studies. Select the best COMLEX level 2 CE materials. The key to succeeding on Level 2 or Step 2 is consistency; simply attempt to answer some questions and read something every day. Throughout each cycle, you must also read. Throughout the day is the best time to do this. It is important to be efficient.

The COMLEX is not as difficult as the USMLE. It isn’t necessarily easier, but it can be more complicated in some cases.

COMLEX stands for Comprehensive Osteopathic Medical Licensure Examination.

COMLEX-USA Level 1 is a problem-and-symptom-based assessment that integrates foundational biomedical sciences with other areas of medical knowledge relevant to solving clinical problems and promoting and maintaining health while providing osteopathic medical care to patients in a time-measured environment.

Bring your driver’s license or other government-issued ID with your complete name, as well as food and drinks.

In most cases, COMLEX Level 2 is completed in the third or fourth year of medical school.

During your second year of osteopathic medical school, take the COMLEX Level 1 test.

After passing the COMLEX Level 1 PE Exam, students will be able to take their COMLEX Level 2 PE Exam.

Related Medical Practice Tests

If you are preparing for a career in medical, you may also find these related practice tests helpful:

Prepare for the USMLE - United States Medical Licensing Examination — the United States Medical Licensing Examination for medical school graduates seeking to practice medicine in the US.

Prepare for the MCAT - Medical College Admission Test — the Medical College Admission Test required for admission to medical schools in the US and Canada.

Prepare for the PLAB 1 - Professional and Linguistic Assessments Board Part 1 — the PLAB Part 1 exam for international medical graduates seeking to practice in the United Kingdom.

Prepare for the PLAB 2 - Professional and Linguistic Assessments Board Part 2 — the PLAB Part 2 clinical assessment for international doctors applying for UK medical registration.

Prepare for the PANCE Test — the Physician Assistant National Certifying Exam for PA program graduates entering clinical practice.

Sample COMLEX-USA Practice Questions

Try these questions from our free COMLEX-USA practice tests. The correct answer and an explanation follow each question.

1. A patient develops fever, purulent wound discharge, and erythema on post-op day 5 from an appendectomy. The most likely cause is:

   • A. DVT
   • B. Atelectasis
   • C. Wound infection
   • D. Pneumonia

Answer: C. Wound infection

Wound infection typically presents 3–7 days after surgery with fever, erythema, warmth, and purulent discharge at the incision site.

Answer: A. Counterstrain and HVLA

A.T. Still's original technique combines elements of counterstrain positioning with an HVLA-type activating force through the barrier.

Answer: C. Primaquine

Primaquine generates oxidative stress that overwhelms G6PD-deficient RBCs, leading to hemolysis; always screen for G6PD before prescribing.

Answer: D. Weakness in finger abduction

Explanation: Guyon's canal (pisohamate) is found at the wrist. The pisiform bone is on the medial border, the hamate is on the lateral border, the flexor retinaculum is on the roof, and the pisohamate ligament is on the floor. The Guyon's canal houses the ulnar nerve. The hypothenar muscles, adductor pollicis, interossi, and 3rd and 4th lumbricals would all be affected by nerve entrapment. Abduction and adduction of the fingers are controlled by the interossi.

Take the full COMLEX-USA practice test